Forgotten Memories, Personal and Political

It’s no coincidence that the new O’Shaughnessy’s includes five articles on post traumatic stress disorder and three on forgotten aspects of the history of cannabis as medicine. When a medical student named Tod Mikuriya first became interested in cannabis in the early 1960s, he realized that understanding might be found in two directions: clinical experience (input from patients, then unavailable) and the pre-Prohibition medical literature. So it makes sense that some 40 years later the journal Mikuriya founded would focus on a psychiatric condition that cannabis is being used to treat, and would publish documents filling in the gaps in our historic miseducation.

The PTSD pieces include three patients’ stories and two articles by clinicians, including one by Mikuriya himself, rife with original observations: ” Although it is now widely accepted that cannabinoids help extinguish painful memories, my clinical experience suggests that ‘extinguish’ is a misnomer. Cannabis modulates emotional reactivity, enabling people to integrate painful memories -to look at them and begin to deal with them, instead of suppressing them until a stimulus calls them forth with overwhelming force. “The modulation of emotional response relieves the flooding of negative affect. The skeletal and smooth muscle relaxation decreases the release of corticosteroids and escalating “fight-or-flight” agitation. The modulation of mood prevents or significantly decreases the symptoms of anxiety attacks, mood swings, and insomnia. While decreasing the intensity of affectual response, cannabis increases introspection as evidenced by the slowing of the EEG after initial stimulation. Unique anti-depressive effects are experienced immediately with an alteration in cognition. Obsessive and pressured thinking give way to introspective free associations (given relaxed circumstances). Emotional reactivity is calmed, worries become less pressing. Used on a continuing basis, cannabis can hold depressive symptoms at bay. Agitated depression appears to respond to the anxiolytic component of the drug. Social withdrawal and emotional shutting down are reversed. The short-term memory loss induced by cannabis that may be undesirable in other contexts is therapeutic in controlling obsessive ideation, amplified anxiety, and fear of loss of control ignited by the triggering stimuli.”

The patients’ stories are from survivors of combat (Al Byrne) and sexual abuse (Erin Hlidebrandt, Christopher Largen), and all took courage to tell. Byrne said after talking at the recent Patients Out of Time conference in Santa Barbara that he’d left out some points he’d meant to make. (Don’t we all, all the time?). Byrne calls the condition post-traumatic stresss – ” not a disorder but a logical response to people trying to kill you.” His afterthoughts:

“PTS can be ‘inflicted’ in 3 ways. You are a victim, you are the cause of trauma, you are a witness. When I spoke to my early years experience in the Navy I meant to point out that these events caused no trauma. There was no negative consequence for me personally. However the Vietnam experience was different. The story I related was as a witness to a major bombing of jungle/people, that was a traumatic event

“Hopefully, treatment quickly is the norm. For instance: I was still working at combat counseling when the first vet from the first gulf war came in. He was going nuts when his friends hit a pothole in the street or went over a bump. Why? Turned out he was with the first troops to drive, at speed, into Kuwait City. The drivers were ordered to stop for nothing, the bumps were bodies, alive and dead, that the trucks he was in had crushed. We hope we got him doing ok and his coming to us quickly was a big help. Please stress the importance of getting trauma folks help right away.”

In the star chamber night Forgotten are the scents of old Tonkin Four-hundred twenty to one For war what’s another forty billion? They’ve got what’s called a gang mentality ‘Cept you, Barbara Lee, ‘Cept you, Barbara Lee, ‘Cept you.

On the next-to-last day of 1996 Drug Czar Barry McCaffrey reiterated the Clinton Administration’s opposition to the medical use of marijuana at a well-attended White House press conference. He was flanked by Attorney General Janet Reno, Health & Human Services Secretary Donna Shalala, and Alan Leshner, head of the National Institute on Drug Abuse. The key visual element was a large chart on an easel to which McCaffrey kept referring with scorn. The heading read “Dr. Tod Mikuriya’s (215 Medical Advisor) Medical Uses of Marijuana.” Twenty-six conditions were listed in two columns of 13. One of the conditions was misspelled as “Migranes.”

As Shalala gazed at the chart and nodded agreement, McCaffrey told the media, “This isn’t medicine, this is a Cheech and Chong show.” He warned that use of marijuana violated federal law and would lead to reprisals, including the loss of prescription-writing privileges for any doctor who recommended it to patients. Reno said that prosecutors would focus on doctors who were “egregious” in recommending marijuana.

In a New Year’s Day interview at his home in the Berkeley hills, Mikuriya analyzed the set-up for a UCSF med student: “As doctors become more fearful, I’ll obviously get more and more patients who are using cannabis or are considering it. Will that make it seem that there’s something ‘egregious’ about my practice?”

Mikuriya called the chart “a crude dirty trick -the kind of disinformation the U.S. military put out during the Vietnam War. Only in this case the ‘enemy’ is the people of California.”

Your correspondent subsequently interviewed the McCaffrey aide who compiled the chart, Dave Des Roches, “special assistant for strategy planning,” a West Pointer who had retired from the Army after nine years and moved over from the Pentagon to the Drug Czar’s office.

Des Roches said he’d based the chart on Mikuriya’s “Medical Marijuana Handbook” as posted on the Internet. He explained: “What he does there is put in every use in recorded history of marijuana for medical purpose. I’m sure he’ll say ‘I’m not endorsing this,’ but it’s on the internet, it’s published, his name is on the front of it.”

Des Roches thought that some of the conditions Mikuriya listed were especially ludicrous: “‘Writer’s cramp’ -I had to show that one to General McCaffrey, he didn’t believe it. ‘Removal of corns’ -because it was sold in patent medicines! And can you believe ‘Recall of forgotten memories?’ He bases that on something from John Stuart Mill!” (At the time there had been a spate of highly publicized cases involving false accusations based on “recovered memories” of abuse during childhood.) Des Roches was highly amused by Mikuriya’s “whole laundry list” of conditions for which marijuana provides relief, and so was his boss, McCaffrey, in front of a worldwide TV audience on 12/30.

It would turn out that the very thing the brass were ridiculing Mikuriya for -his documentation that cannabis can be used to treat an astonishingly wide range of conditions- is, arguably, his most significant accomplishment. The implications of cannabis’s versatility have been developed by Mikuriya and other clinicians in the 10 years since Prop 215 passed, and by lab scientists, too. Cannabinoids are now known to affect the cardiovascular, digestive, endocrine, excretory, immune, musculo-skeletal, nervous, reproductive, and respiratory systems!

As a clinician observing the effects of cannabis on human beings who provide verbal feedback (unlike mice and dogs), Mikuriya inferred its mechanism of action and defined it as “an easement” (rather than a sedative, hypnotic, hallucinogen, etc.) because in both the physical and mental realms, cannabis has a relaxing effect.

O’Shaughnessy’s is the journal I produce for Dr. Mikuriya’s Society of Cannabis Clinicians. To get the Spring ’06 issue and future issues, send a contribution of any amount to CCRMG, p.o. Box 9143, Berkeley, CA 94709. It’s a 501c3 organization, so your contribution is tax-deductible. (CCRMG stands for California Cannabis Research Medical Group, the original name of the SCC. They changed it because it sounded too Jewish. That’s a joke.) This appeal won’t be accompanied by a thermometer rising to $24,000, but keeping the good ship O’Shaughnessy’s afloat is a most worthy cause. This whole medical marijuana movement rests on the courage of a small group of doctors, and it’s important that they have an outlet in which to publish their findings and observations.